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Use of retail clinics rises, but…



A new study from the Blue Cross Blue Shield Association shows progress as insurers try to change their customers’ healthcare  use in order to cut costs.

The study found that among commercially insured BCBS plan members, visits to retail clinics nearly doubled in the past five years, from 12.2 visits per 1,000 members to 24 visits per 1,000 members.

The study says that up 29.8 percent of hospital emergency department visits could be handled at retail clinics. Emergency department visits, of course, are famously expensive. And so, insurers now cover most retail clinic visits.

But FierceHealthcare noted that the rise in use of retail clinics was not equally distributed among those with commercial BCBS plans. “For example, the rate at which women visited retail clinics was 72% higher than the rate for men in 2015.

“In addition, uptake among individually insured members has ‘lagged’ since the implementation of the Affordable Care Act, according to the BCBSA. From 2013 to 2015, the growth rate in retail clinic visits per 1,000 members in the individual market was only 2.6%, compared to a 15.5% growth rate in doctor’s office visits and 35.8% uptick in ED visits.’’

‘’In 2015, there was also a 19% lower use of retail clinics among individually insured members compared to members with employer-based plans.’’

To read the study, please hit this link.

To read FierceHealthcare’s comment on it, please hit this link.

4 ways Trump could affect hospital revenue cycle


Becker’s Hospital Review presents four ways  in which President-elect Donald Trump’s proposed healthcare reforms could affect hospitals’ revenue cycle:

“1. Tax-free, inheritable health savings accounts. Mr. Trump said he would sign legislation to promote tax-advantaged HSAs to encourage consumers with high-deductible health plans to set aside money for out-of-pocket healthcare costs.

“Mr. Trump would also tie HSAs to a person’s estate, meaning an account could pass on to next of kin without facing federal taxes.”

“2. Federal mandate for provider price transparency. Mr. Trump said he would require ‘all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals,’ to disclose service prices to consumers prior to treatment. This could speed the rate of price transparency adoption at hospitals across the nation.”

“3. New Medicaid funding method. Mr. Trump proposed dismantling financing for Medicaid expansion under the ACA and converting the program to a block grant to contain healthcare costs. Block grants would give states more authority over their Medicaid programs in exchange for accepting a fixed amount of funding from the federal government. This means states would not be required to cover certain groups of people, such as children, pregnant women and the elderly, to receive federal money. ”

“4. Repeal of the ACA. Mr. Trump vowed to repeal the ACA as one of his first presidential acts. Bill HR 3762, introduced into Congress October 2015, would: repeal ACA tax credits, end Medicaid expansion, repeal major taxes used to fund insurance expansion and create a two year transition period to dismantle ACA infrastructure. The Congressional Budget Office estimated 22 million people would lose insurance if HR 3762 is signed into law without a Republican replacement plan. The rise in uninsured Americans could negatively affect healthcare providers by increasing their uncompensated care and bad debt rates to pre-ACA levels.”

To read the full article, please hit this link.

Bigger clinic competitor


Walgreens’s plan to buy Rite Aid for about $9.4 billion means that CVS will have a more powerful competitor to deal with. The would-be merger partners together have about 13,000 U.S. stores.

If antitrust regulators approve the deal, it means that hospital systems and physician groups will have both a stronger collaborator and a stronger competitor — the latter given the big push by drugstore chains to open many more clinics in their stores with some services competing with those  of hospitals and physicians.

Further, the chain would have more bargaining power with the drug companies.









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